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The Dual Control Model of Sexual Response: Relevance of Sexual Excitation and Sexual Inhibition for Sexual Function

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Abstract

Purpose of Review The dual control model of sexual response aims to explain sexual behavior and response through two factors, labeled sexual excitation and sexual inhibition. Sexual dysfunctions are common among women and men and pose a threat to the sexual health of both genders. The main objective of this paper was to review the latest findings concerning the predictive value of sexual excitation and sexual inhibition for sexual function and dysfunction in men and women. Recent Findings Most relevant studies have been conducted in North America and Europe using non-clinical samples. Women and men with high sexual inhibition related to performance concerns and distractibility during sex report lower sexual function. In addition, high sexual excitation is associated with higher sexual function in both genders. Summary Sexual excitation and sexual inhibition are predictors of sexual function in women and men. More prospective and clinical studies are needed to evaluate the usefulness of both propensities as predictors or moderators of treatment success.
INTEGRATING THE PSYCHOSOCIAL (B MCCARTHY, RT SEGRAVES AND AH CLAYTON, SECTION EDITORS)
The Dual Control Model of Sexual Response: Relevance of Sexual
Excitation and Sexual Inhibition for Sexual Function
Julia Velten
1
#Springer Science+Business Media, LLC 2017
Abstract
Purpose of Review The dual control model of sexual response
aims to explain sexual behavior and response through two
factors, labeled sexual excitation and sexual inhibition.
Sexual dysfunctions are common among women and men
and pose a threat to the sexual health of both genders. The
main objective of this paper was to review the latest findings
concerning the predictive value of sexual excitation and sex-
ual inhibition for sexual function and dysfunction in men and
women.
Recent Findings Most relevant studies have been conducted
in North America and Europe using non-clinical samples.
Women and men with high sexual inhibition related to perfor-
mance concerns and distractibility during sex report lower
sexual function. In addition, high sexual excitation is associ-
ated with higher sexual function in both genders.
Summary Sexual excitation and sexual inhibition are predic-
tors of sexual function in women and men. More prospective
and clinical studies are needed to evaluate the usefulness of
both propensities as predictors or moderators of treatment
success.
Keywords Dual control model of sexual response .Sexual
excitation .Sexual inhibition .Sexual dysfunction .Sexual
function
Introduction
Being satisfied with ones intimate relationships and sexual life
is important for mental and physical health. Sexual satisfaction
is associated with better self-perceived general health, greater
psychological well-being and happiness [14], lower levels of
depression and anxiety [57], as well as greater partnership
satisfaction [8]. While experience of low desire for or interest
in sexual activities, difficulties with sexual arousal or orgasm,
and genito-pelvic pain are common sexual problems among
women, men are most likely to be concerned about obtaining
or maintaining an erection or early ejaculation [9]. The numer-
ous associations between sexual, mental, and physical health
underline the relevance of identifying predispositions and risk
factors for the development of sexual difficulties.
Dual Control Model of Sexual Response
The dual control model of sexual response offers a theoretical
framework to systematically assess factors that may predis-
pose sexual difficulties [10]. According to this model, individ-
uals differ in two propensities that facilitate or diminish sexual
response in any given situation. Individuals are supposed vary
across these two factors, called sexual excitation (SE) and
sexual inhibition (SI), with a close to normal distribution
[1113]. This assumption has been confirmed in samples of
men and women with different sexual orientations both inside
and outside the United States [1316]. While most levels of
SE and SI are assumed to be related to adaptive sexual behav-
ior or function, high levels of SI as well as low levels of SE are
expected to be associated with increased vulnerability for sex-
ual dysfunctions. High SE, especially when combined with
low SI, has been shown to increase the likelihood of high-
risk sexual behavior [17].
This article is part of the Topical Collection on Integrating the
Psychosocial
*Julia Velten
julia.velten@rub.de
1
Faculty of Psychology, Department of Clinical Psychology and
Psychotherapy, Ruhr-Universität Bochum, Massenbergstrasse 9-13,
44787 Bochum, Germany
Curr Sex Health Rep
DOI 10.1007/s11930-017-0108-3
This review provides an overview of the latest findings
concerning SE and SI as predictors of sexual function and
dysfunction in women and men. First, the different self-
report questionnaires that have been developed to assess SE
and SI in men and women, are presented. Describing the con-
tent and factor structure of these scales is helpful to evaluate
the significance of specific aspects of SE and SI for sexual
function. The following sections describe the relevance of SE
and SI for sexual function in women and men, respectively.
Finally, the findings are discussed with a focus on gaps in the
literature as well as possible implications for future research
and clinical practice. The latest, comprehensive review about
the dual control models relevance for different sexuality re-
lated outcomes was published in 2009 [17]. The present pa-
per will focus on studies that have investigated SE and SI with
respect to sexual function and have been published afterwards.
Method
In February 2017, a literature search was conducted using
Web of Science and PubMed. The following syntax was used:
(sexual excitationOR sexual inhibitionOR (dual control
modelAND sexual)) to find relevant studies that were
published since 2008. Papers published earlier were identified
by using the review by Bancroft et al. [17]. In addition, au-
thors of previous papers were contacted and asked to provide
information about possible in press papers. A total of 134
papers were screened to assess their relevance for the present
study. Twenty-eight papers that targeted SE, SI, and sexual
function in humans were included in this review. These stud-
ies focused on validation or translation of different question-
naires to assess SE and SI or included data on the impact of SE
and SI for womensormens sexual function.
Measuring SE and SI
At least four different self-report questionnaires have been
developed to assess SE and SI in male and female samples.
An overview of these scales is presented in Table 1. The first
questionnaire that was created to assessthe two propensities in
male samples was the Sexual Excitation Scale/Sexual
Inhibition Scales (SIS/SES) [12]. This 45-item self-report in-
strument has three higher order factors, one reflecting SE (e.g.,
being easily aroused by sexual fantasies or other stimuli;
SES), the other two relating to SI due to threat of performance
failure (e.g., losing ones erection; SIS1), as well as inhibition
due to threat of performance consequences (e.g., sexually
transmitted infections; SIS2). The SIS/SES also includes ten
lower order factors which tap into specific facets of SE and SI.
Although the SIS/SES was originally developed to describe
stimuli and behavior that were supposedly relevant for mens
sexual arousal, the scale also shows satisfactory convergent
and discriminant validity in women [11]. In line with the
models assumptions, a significant gender difference was
found with men consistently showing higher levels of SE,
and lower levels of SI than women [11]. However, within-
gender variability was much greater than differences between
genders. In 2011, a 14-item short version of the SIS/SES was
published [24]. Consisting only of the three higher order fac-
tors (SES, SIS1, and SIS2), this scale can be used when time
or resources are limited. Items were selected to be fully mea-
surement invariant for men and women. As the scale consists
only of themes that are equally relevant for women and men,
gender comparisons of SE and SI are feasible.
Despite the satisfying psychometric properties of the SIS/
SES in a female sample [11], it was questioned whether the
scale was equally suited for use in women. Therefore, another
36-item self-report questionnaire was developed based on re-
sults of a focus group study to identify topics that are specif-
ically relevant for female sexual arousal and desire [25]. The
Sexual Excitation/Sexual Inhibition Inventory for Women
(SESII-W) assesses SE and SI with five and three lower order
factors, respectively [26]. Psychometric properties (i.e., con-
struct validity, internal consistency and test-retest reliability)
of the original version [26]aswellasDutch[16], Spanish
[22], and German [15] translations were acceptable to good
and comparable across versions. To assess the validity and
reliability of all translated versions will be an important step
to ensure comparability across languages [27].
Based on the same item-pool as the SESII-W, another ques-
tionnaire was developed for the use in women and men. The
Sexual Excitation/Sexual Inhibition Inventory for Women and
Men (SESII-WM) includes 30 items that are measurement
invariant across genders [28]. While having substantial over-
lap with the SESII-W19 items are used in both scales
factor structure and remaining items differ between the two
instruments, which prevents researchers from directly com-
paring results from both questionnaires.
To sum up, several, well-validated questionnaires are avail-
able to assess SE and SI in men and women. The scales of the
SIS/SES, SESII-W, and SESII-WM are, however, not directly
comparable. More research is needed to determine which
scale is most appropriate to assess the two propensities of
the dual control model in male and female samples and to
clarify which instrument can predict specific sexuality-
related outcomes such as sexual function or sexual risk-
taking most effectively.
Dual Control Model and Sexual Function in Women
In 2008, the first study investigating the relationship between
SE, SI, and sexual problems in women was published using
the SESII-Win a non-clinical sample of 540 women [29]. The
Curr Sex Health Rep
Tab l e 1 Comparison of different self-report questionnaires for sexual excitation and sexual inhibition
Sexual Excitation Scales/Sexual
Inhibition Scales
(SIS/SES)
Sexual Excitation Scales/Sexual
Inhibition Scalesshort form
(SIS/SES-sf)
Sexual Excitation/Sexual Inhibition
Inventory for Women
(SESII-W)
Sexual Excitation/Sexual Inhibition
Inventory for Women and Men
(SESII-W/M)
No. of items 45 14 36 30
Versions Male and female version Male and female version Female version One version for men and women
Translated versions* German [18], Hindi [19], Urdu [20],
Panjabi [20], Tamil [20],
Sinhalese [20]
Dutch, German [18], Spanish [21]Dutch[16], German [15], Italian,
Polish, Portuguese, Spanish [22]
German, Portuguese [23]
Factor structure Sexual excitation (SES)
- Social interactions
- Visual stimuli
- Fantasizing about sex
- Non-specific stimuli
Sexual inhibition due to the threat of
performance failure (SIS1)
- Losing arousal easily
- Partner concerns
- Performance concerns
Sexual inhibition due to the threat of
performance consequences (SIS2)
- Risk of being caught
- Negative consequence
- Pain/norms and values
Sexual excitation (SES)
Sexual inhibition due to the threat of
performance failure (SIS1)
Sexual inhibition due to the threat of
performance consequences (SIS2)
Sexual excitation (SE)
- Arousability
- Partner characteristics
- Power dynamics
-Smell
- Setting (unusual/unconcealed)
Sexual inhibition (SI)
- Concerns about sexual function
- Arousal contingency
- Relationship importance
Sexual excitation (SE)
- Arousability
- Partner characteristics and
behaviors
- Setting (unusual/unconcealed)
Sexual inhibition (SI)
- Inhibitory cognitions
- Relationship importance
- Dyadic elements of the sexual
interaction
Note. * Published translations and validation studies are provided if available
Curr Sex Health Rep
two strongest associations with both current and lifetime sex-
ual problems were the inhibitory factor arousal contingency,
which describes how everything has to be just rightfor
sexual arousal to occur, and concerns about sexual function,
which describes the loss of arousal due to worries about being
a good lover or taking too long to reach orgasm. These find-
ings were in line with the theoretical assumption of the dual
control model that high SI is linked to vulnerability to sexual
problems. The generalizability of the findings, however, was
limited by the use of a non-clinical convenience sample and
exclusion of non-heterosexual women. In addition, single item
questions instead of validated questionnaires were used to
assess sexual function and only cross-sectional data was used.
Since then, several studies have been conducted to overcome
these limitations and to further explore which aspects of SE
and SI are the most relevant for sexual function in women.
A Dutch study examined and confirmed the discriminative
validity of the SESII-W for sexual problems in a sample of
259 women with and 186 women without sexual problems
[16]. Again, the arousal contingency factor discriminated best
between these two subsamples. A strength of this study was
the use of a semi-structured diagnostic interview based on the
Diagnostic and Statistical Manual of Mental Disorders IV
(DSM-IV) [30] criteria of female sexual dysfunctions in a
subsample of participants. This procedure allowed for conclu-
sions about the relevance of the dual control model for clinical
female sexual dysfunctions. Another study compared different
sexuality-related variables between healthy controls and
women with different sexual concerns, namely low sexual
desire and/or arousal difficulties [31]. In line with previous
findings, women with sexual difficulties reported lower SE
and higher SI. Compared to women with one sexual dysfunc-
tioneither low desire or arousal difficultieswomen with
low desire and arousal problems reported even higher levels of
SI [31].
Homosexual or bisexual women differ from heterosexual
women with respect to sexuality-rated traits or attitudes such
as sociosexual orientation and sexual interest [32,33].
Therefore, one study aimed to replicate previous findings
concerning womens sexual function and the dual control
model using the SESII-W in a sample of sexual minority
women (n= 733 bisexual women, n= 241 lesbian/
homosexual women). While controlling for age, relationship
duration, and relationship status, four lower order factors of
the questionnaire were predictive of sexual problems. As ex-
pected, arousal contingency and concerns about sexual func-
tion were positive predictors of sexual problems in homosex-
ual and bisexual women. Interestingly, relationship impor-
tance was a negative predictor suggesting that women who
emphasize the need for trust and commitment in order to get
aroused report higher sexual function. Partner characteristics,
a lower order factor of SE, was predictive of sexual problems,
indicating that women who are easily aroused by certain
attributes of a sexual partner reported more sexual problems.
A possible explanation of this finding is that women who rely
on partner characteristics or behavior in order to get aroused
might be prone to sexual difficulties if their current partner
does not meet their standards or desired attributes [29]. The
authors conclude that the SESII-W can be used to reliably and
validly to assess the factors of the dual control model in sexual
minority women and that the associations between SE, SI, and
sexual function in these samples are comparable to the asso-
ciations found in heterosexual women [14••].
Age-related changes have been found with respect to dif-
ferent aspects of womens sexual well-being. Older and post-
menopausal women often experience lower sexual function
compared to younger and premenopausal women [34,35].
To evaluate if the propositions of the dual control model also
apply to older women, researchers examined the relationships
between SE, SI, and different sexuality-related outcomes in a
sample of 185 women 50 years and older (M= 59.46,
SD =6.96)[36]. The pattern of results was similar to studies
with younger women [16,37••]. Three aspects of SE
(arousability, smell, and partner characteristics) were positive
predictors, while two factors of SI (arousal contingency and
concerns about sexual function) were negative predictors of
sexual function. Compared to other factors of the SESII-W,
arousal contingency was the strongest predictor of sexual
function in older women [36].
Sexual traumatisation, especially childhood sexual abuse,
constitutes an important risk factor for sexual difficulties in
adult women [9]. Women with a history of sexual abuse in
childhood reported higher SI andwhen controlling for body
esteemlower SE than women who had not experienced sex-
ual abuse. More research is needed to examine whether the
sexual concerns often experienced by survivors of sexual
abuse are mediated by SE and/or SI [38].
High SE and low SI were also associated with sexual desire
in a sample of 29 postpartum and 30 nulliparous women [39].
In addition, group comparisons showed that postpartum wom-
en had lower SE and higher SI related to performance anxiety
than women who never had children [39]. The authors suggest
that women who recently gave birth may be concerned about
pleasing a partner after going through the physical changes
that accompany parturition and the typical lack of sexual in-
teractions in late pregnancy [39].
Compared to healthy controls, women with either a panic
disorder or generalized anxiety disorder had not only lower sex-
ual functioning but also higher levels of SIS1 and SIS2 [40].
Future studies should clarify the relevance of SI for the relation-
ship of anxiety disorders and sexual concerns in women.
A shortcoming of the previously mentioned studies was the
sole use of cross-sectional data. To assess predictor and out-
come variables at the same time does not allow researchers to
estimate the direction of effects. When relying solely on cross-
sectional data, it remains unclear whether SE and SI influence
Curr Sex Health Rep
sexual function or vice versa. It is likely that women who
experience a sexual difficulty such as low desire or problems
with orgasm evaluate their SE and SI levels in the light of their
sexual concern. The first and only published study that aimed
to overcome this limitation [37••] included 2214 participants
and assessed both outcome variablessexual function using
the Female Sexual Function Index and SE and SI using the
SESII-Wat three time-points. On a cross-sectional level,
findings from previous studies were replicated. While control-
ling for partnership status and depressive symptoms, two as-
pects of SI, namely arousal contingency and concerns about
sexual function, were negative predictors, and three aspects of
SE, arousability, sexual power dynamics, and setting (unusu-
al/unconcealed), were positive predictors of sexual function.
Most of these SESII-W subscales were also predictive of sex-
ual function 1 or 2 years later. Arousability and partner char-
acteristics were even predictive of future sexual function
above and beyond baseline sexual function levels.
To assess the impact of partner similarity in SE and SI on
sexual function and sexual satisfaction in a sample of couples
was the aim of another study. Using the SIS/SES question-
naire in a small sample of 35 newlyweds, greater similarity
between partners for SIS1 and SIS2 was associated with fewer
sexual problems in wives. In other words, a mismatch in SI
between partners was related to more sexual problems in
women [41].
There is substantial evidence for the predictive value of SE
and SI for womens sexual function and dysfunction. With
few exceptions, lower order factors of SE were positive, and
lower order factors of SI were negative predictors of sexual
function. Across all studies, the arousal contingency factor
which describes how everything has to be just rightfor
sexual arousal to occur or how easily one is distracted from
sexual arousalwas the strongest predictor. Evidence was
consistent across women of different age groups, sexual ori-
entations, as well as across European and American samples
and using cross-sectional or longitudinal data.
Dual Control Model and Sexual Function in Men
During the late 1990s and early 2000s, Bancroft and col-
leagues applied the dual control models assumptions and pre-
dictions to male sexuality and focused especially on
explaining their relevance for menssexualfunction[10,12,
42]. The importance of centrally acting inhibitory mecha-
nisms as etiological and maintaining factors for erectile prob-
lems was proposed and confirmed [10]. Using the SIS/SES
questionnaire, SIS1 and SIS2 were positive predictors of erec-
tile problems (lifetime) in a sample of 313 heterosexual men
[43,44]. When current erectile problems were assessed, SIS1
was a positive and SES was a negative predictor. Similar as-
sociations for SIS1 and erectile problems were found in a
larger sample of homosexual men [45]. Neither SI nor SE
was, however, predictive of early ejaculation [45]. Since then,
research concerning the dual control model in male samples
has been focusing more strongly on other aspects of mens
sexuality such as sexual risk-behavior or hypersexuality
[4650]; few studies have investigated the relevance of SE
and SI for different aspects of mens sexual function. One
exception is the previously mentioned couples study that
assessed how SE- and SI-similarity between partners is related
to both sexual function and sexual satisfaction. In line with
previous studies, higher SIS1 was associated with erectile
problems in men. In addition, SES was associated with greater
sexual satisfaction. Similarity of SE and SI between partners
was not associated with mens sexual function.
In a sample of 71 men with and without sexual problems,
men with erectile difficulties had lower SIS1 scores, while
men with low sexual desire scored lower on SE compared to
healthy controls [51]. The advantages of this study were the
use of clinical sample and the inclusion of participants with
other than erectile dysfunction.
In a small sample of 19 stroke patients, SES was positively
associated with sexual desire, while SIS1 was negatively cor-
related with several aspects of sexual function such as erectile
function, orgasmic function, sexual desire, as well as inter-
course satisfaction [52]. This study underlines the significance
of SE and SI beyond non-clinical, college-aged samples.
In a sample of 85 men with erectile dysfunction who were
treated with PDE5 inhibitors, SE was significantly higher, and
SIS1 was significantly lower in men with mild compared to
men with moderate erectile problems. Interestingly, both SE
and SI were not stable across the test-retest period of 3 months.
While men with mild erectile problems experienced decreases
in SIS1, men with more severe erectile problems reported
decreases inSE and increases inSIS1 over the 3-month course
of the study [53]. In some men, improvements in erectile
function were related to higher SIS2, reflecting increases in
SI related to fear of consequences of sexual activity. Men with
improved erectile function may have more opportunities for
sexual activity and may therefore experience more concerns
related to the consequences of sexual encounters.
Discussion
The goal of this review was to provide an overview of the
latest findings concerning the relationship between SE, SI,
and sexual function in women and men. Low sexual arousal
or desire are the most common sexual difficulties in women,
while erectile dysfunction and early ejaculation are the most
frequent sexual concerns among men [9]. If a sexual problem
is frequent, enduring, and causes clinically significant distress,
it can be diagnosed as a sexual dysfunction [54]. Sexual prob-
lems or dysfunctionsespecially those related to low desire
Curr Sex Health Rep
and/or arousal difficultiesare related to low SE and high SI
in both women and men. In women, two lower order factors of
SIarousal contingency and concerns about sexual func-
tionare the most significant predictors of sexual problems
across studies. Women who are easily distracted from their
sexual arousal, who need everything to be just rightfor
arousal to occur, and who are sexually inhibited by concerns
about their sexual performance, are more likely to experience
sexual problems. The arousal contingency factor has been
described as an unconscious or automatic inhibitory mecha-
nism, in contrast to a more conscious inhibition, which in-
volves elaborate cognitive control (e.g., de-evaluation of a
sexual partner or worries related to sexual performance or
bodily appearance) [55]. The degree to which a woman per-
ceives herself as distractible from sexual arousal is thereby
significantly associated with her sexual experiences. In men,
the strongest evidence was found for SIS1, which includes
themes that are similar to the two before mentioned inhibitory
factors relevant for women (e.g., having difficulties getting
aroused, losing ones arousal easily, having concerns about
pleasing a partner).
Several studies with female samples have shown the rele-
vance of SE for sexual function. In multivariate analyses, dif-
ferent facets of SE (i.e., partner characteristics, sexual power
dynamics) were independently predictive of female sexual
function [16,29,37••] above and beyond SI. Being easily
aroused by a variety of stimuli may protect women from
experiencing sexual problems, especially those related to
low desire and arousal. The higher order factor of SE was also
predictive of male sexual function in two studies [43,51]. To
the authors knowledge, no published study has examined
which specific aspects of SE are key for sexual problems in
men. Sexually functional individuals perceive themselves as
easily aroused by a multitude of stimuli, including sexual fan-
tasies, partner behavior, visual stimuli, or the feeling of being
desired sexually by a sexual partner, which in turn may pre-
vent sexual difficulties.
Although these findings support the notion of both excit-
atory and inhibitory factors influencing sexual behavior, sev-
eral empirical and conceptual issues remain. Both propensities
combined explain approx. 15% of variance in womenssexual
functioning [37••]. However, it is still unclear how an individ-
ual with a low score of a hypothetical one factor of sexual
arousability/excitability differs from an individual with low
SE and high SI. In addition, preliminary evidence suggests
that the simple equation Greater SE leads to more or stronger
sexual arousalis an oversimplification, at least in female
samples [56,57••]. Sexual response patterns may be more
complex than the dual control model suggests. Lastly, al-
though various centrally acting excitatory and inhibitory path-
ways of sexual response have been identified [42,58], it
remains unclear how these correspond to self-reports of SE
and SI.
Implications for Future Research
The lack of longitudinal data precludes a causal interpretation
of causes and effects [59]. One prospective study using a
female sample has shown the predictive value of SI for future
sexual function [37••]. Therefore, it remains questionable if
low SE and high SI increase the vulnerability for developing
sexual difficulties or are rather consequences of perceived
sexual problems. Only few studies have included participants
that have been diagnosed with a sexual dysfunction or are
actively seeking treatment for sexual concerns [16]. As low
sexual function is much more common than clinically relevant
sexual dysfunctions [60], findings from non-clinical samples
cannot be generalized to clinical populations. In addition,
most studies have focused on general sexual function or have
limited their study to certain sexual concerns such as erectile
difficulties. More research is needed to evaluate the relevance
of SE and SI for problems such as low sexual desire in men,
orgasmic difficulties, or genital pain. To assess the value of SE
and SI as predictors or mediators of treatment success might
also be of further interest.
Clinical Implications
This review underscores the relevance of SE and SI for sexual
dysfunctions in men and women. As both propensities are
significantly associated with sexual function in both genders,
psychosocial interventions that aim to reduce inhibitory fac-
tors (e.g., sexual concerns, distractibility) while also targeting
SE, for example by improving sexual communication or iden-
tifying adequate sexual stimuli, may be promising.
Treatment research suggests that various psychological in-
terventions can effectively improve sexual function in men
and women [5,61,62]. Cognitive-behavioral treatment pro-
grams often include a number of different interventions such
as sexual and psychological education, behavioral sex-therapy
exercises, or cognitive restructuring of sexuality-related
thought biases [62]. Self-exploration and sensate focus exer-
cises may help individuals with low SE to familiarize them-
selves with their sexual responses and to identify which stim-
uli they find most arousing. In addition, these exercises may
also reduce performance anxiety related to high SI.
Mindfulness-based interventions that aim to increase a
non-judgmental acceptance towards bodily, and especially
sexual, perceptions, and (negative) thoughts [63]havebeen
found effective in improving sexual concerns in women with
different sexual dysfunctions [19,64,65]. Mindfulness exer-
cises might be effective to target problems related to high SI
(e.g., promote acceptance of distracting thoughts or worries)
and low SE (e.g., strengthen focus on the present moment and
on bodily sensations). In addition, cognitive interventions can
Curr Sex Health Rep
be effective to identify automatic thoughts that are related to
SE and SI [66].
Psychological interventions for sexual dysfunction in gen-
eral and arousal difficulties in particular should address both
low SE and high SI in order to improve sexual functioning.
Thus far, psychosocial treatment programs for sexual con-
cerns have mostly followed a one size fits allapproach
and have not specifically addressed issues related to low SE
and high SI. It may be beneficial to explore which interven-
tions are particularly effective for individuals with a medium-
risk profile for sexual difficulties such as high SE/SI or low
SE/SI.
Compliance with Ethical Standards
ConflictofInterest Julia Velten declares no potential conflict of
interest.
Human and Animal Rights and Informed Consent This article does
not contain any studies with human or animal subjects performed by the
author.
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... Although the effects of depression on the inhibitory/excitatory system are not well established, lower levels of serotoninergic associated with depression and higher levels of catecholamine associated with anxiety may increase overall inhibitory tone while having only minor effects on excitatory tone [16]. A few recent studies [18][19][20][21][22][23][24][25][26][27][28] showed a correlation between sexual functioning and SE/SI, such that women with sexual problems, sexual distress, or other sexual concerns had lower SE scores (primarily in Arousability) and higher SI scores as compared to women without sexual concerns. However, the aforementioned studies used screening questionnaires, such as the Female Sexual Function Index (FSFI) and Female Sexual Distress Scale (FSDS), to assess sexual problems. ...
... Results of that longitudinal study demonstrated that having a steady sexual partner, Arousability, Sexual Power Dynamics, and Settings were positive predictors of present and future sexual functioning, whereas depressive symptoms, Arousal Contingency, and Concerns about Sexual Function were negative predictors of current and future sexual functioning [18]. Similar results were obtained by a study of 373 women (mean age = 34.1 years) by Quinta et al. in Spain [24,25]. Quinta et al. demonstrated that SE predicted desire, arousal, lubrication, and orgasm, as measured by the FSFI [24,25]. ...
... Similar results were obtained by a study of 373 women (mean age = 34.1 years) by Quinta et al. in Spain [24,25]. Quinta et al. demonstrated that SE predicted desire, arousal, lubrication, and orgasm, as measured by the FSFI [24,25]. Only one Dutch study used DSM-IV criteria to assess FSD, and found that the presence of FSD was associated with lower total and subscale SE scores, and higher total and subscale SI scores [11]. ...
Article
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The contemporary concept of sexual counseling for women with sexual problems, distress, and female sexual dysfunction (FSD) includes tailored medical and/or psychological intervention. The dual control model and the Sexual Excitation/Sexual Inhibition Inventory for Women (SESII-W) are helpful for identifying risk factors and tailoring therapy for FSD. The current study aimed to (1) validate the Polish translation of the SESII-W in a sample of Polish women, and (2) verify the usefulness of the SESII-W in clinical practice. Five hundred nine white women age 18 to 55 years old ( M ± SD age = 39.7 ± 11.3 years) were included in this cross-sectional study. Linguistic validation of the Polish translation of the SESII-W was first performed. A battery of tests was then used to evaluate reliability, convergent and discriminant validity, measurement invariances, and correlations between the SESII-W and other measures. Given that the original version of the SESII-W had unsatisfactory model fit, exploratory and confirmatory factor analyses were subsequently performed. Results showed a new final model that included 26 items with seven lower- and two higher-order factors and explained 58.9% of the variance in the data, with CFI = 0.93, RMSEA = 0.05 and χ ² = 693.39, p < 0.001. Cronbach’s α was 0.77 for Sexual Excitation (SE) and 0.88 for Sexual Inhibition (SI) scales. A moderate negative association between SI and the presence of FSD according to Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria was noted. SE was positively associated with engaging in risky sexual behaviors, Extraversion and Openness to Experiences traits, and was negatively correlated with relationship quality. Finally, age was negatively correlated with all domains of the SESII-W except Arousal Contingency. SE and SI were both lower in older women as compared to younger once. These results demonstrate that the Polish version of SESII-W shows good psychometric properties. A higher propensity for SI was associated with the presence of sexual problems, distress, and FSD, whereas a higher propensity for SE was associated with greater engagement in risky sexual behaviors and personality type. However, future studies on larger and more diverse populations are required to confirm the replicability of the factor structure of the scale.
... Aligned with this reasoning, past research has shown that individuals concerned with external threats (e.g. STI transmission) are likely to inhibit their sexual responses, have lower sexual desire, are less inclined to seek out sexual stimuli, have less positive attitudes towards casual sex, are less prone to sexual risks, and have greater germ aversion (Bancroft et al., 2009;Duncan et al., 2009;Murray et al., 2013;Velten, 2017). A similar effect was observed when a COVID-19 threat was experimentally made more salient to participants (Moran et al., 2021). ...
... As such, individuals more focused on prevention at T1 should perceive more pandemic-related threats two weeks later (T2; Hypothesis 2). As threat perceptions have been associated with risk-taking, sexual functioning, and sexual behaviours (Bancroft et al., 2009;Duncan et al., 2009;Hensel et al., 2020;Ko et al., 2020;Murray et al., 2013;Velten, 2017), we also expected threat perceptions to explain the negative impact of a predominant prevention focus on sexual activity (Hypothesis 3). These hypotheses are depicted in Figure 1 and were pre-registered on the Open Science Framework (OSF). ...
Article
Amidst a global pandemic, survival needs become salient and the ability of individuals to regulate feelings and actions might be particularly relevant to protecting themselves from harm. Drawing from Regulatory Focus Theory individuals who are more focused on prevention are also more likely to enact health-protective behaviours, including sexual health behaviours, because they are more aware of threats. Extending this reasoning to the COVID-19 pandemic, we conducted a pre-registered longitudinal study with 174 individuals from 23 countries (Mage = 30.66, SD = 11.81; 77.6% women), to examine the role of regulatory focus in predicting the sexual activity of single individuals. We assessed demographic information, regulatory focus, and personality traits at baseline (T1), perceived threats two weeks later (T2), and sexual activity indicators two weeks later (T3). As hypothesised, results showed that single individuals who reported a greater focus on prevention at the onset of the pandemic perceived more pandemic-related threats and, in turn, reported less frequent sexual activity. These effects were consistent even when controlling for promotion (i.e. pleasure motives), personality, geographic location, local social distancing policies, gender, and sexual orientation. Findings are discussed considering their implications for the sexual functioning and sexual health of single individuals.
... While the SES would prompt approach motivation, inhibition systems would prompt avoidance of sexual behaviors because of their potential risks. While adaptative (Bancroft, 1999), the over-or under-sensitivity of these systems could result in sexual selfregulation problems, both in terms of sexual functioning and problematic sexual behaviors (see Nolet, Wilson, &Rouleau, 2017 andVelten, 2017 for reviews). Evidence suggests that being easily excited (SES), being highly inhibited by threats to performance (SIS1), or lacking inhibition from potential social consequences of sexual arousal (SIS2) can lead, when associated with other factors, to sexual risk-taking (e.g., Bancroft et al., 2004), sexual coercion perpetration (e.g., Carvalho, Quinta-Gomes, & Nobre, 2013), or hypersexuality (e.g., Walton, Cantor, & Lykins, 2017). ...
... Both excitability (SES) and inhibition (SIS1) had a unique contribution to the prediction of sexual attentional bias. The tendency to be sexually inhibited by threats of performance failure (SIS1) is associated with erectile dysfunction (ED) in both heterosexual and homosexual men (Velten, 2017). Being easily distracted from sexual stimuli by non-sexual thoughts (de Jong, 2009), such as those around performance anxiety (Bancroft, Carnes, Janssen, Goodrich, & Long, 2005), is commonly proposed as a psychological mechanism for ED. ...
Article
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Being sexually aroused can lead to a stronger propensity to engage in sexual risk-taking and sexually coercive behaviors possibly by narrowing attentional focus toward immediate gratification rather than long-term consequences. The goal of this paper was to investigate the attentional processes implicated in sexual self-regulation failure and its moderating factors, namely having a stronger sensitivity to sexual cues (dual control model) or being less able to implement behavioral intentions (action control theory) following a first effortful task. A total of 82 young adult heterosexual men completed a Dot Probe task to assess their attentional bias toward sexual stimuli. Effortful control was manipulated using a Stroop task. Regardless of conditions, higher sexual excitability was predictive of a stronger attentional bias toward sexual cues, while higher inhibition due to threat of performance failure was predictive of a lower bias for such cues. In the experimental condition, action-oriented individuals were able to negate this attentional bias by staying more focused on the task, while state-oriented participants showed higher orientation toward the sexual cues and thus a higher bias. These results suggest that both higher-order processes, like intention implementation, and lower-order processes, like sexual inhibition and excitation systems, are the key to regulation failure.
... This measure further divides sexual inhibition into two separate factors, where the first (SIS1) is hypothesized to measure sexual inhibition due to performance failure, whereas the other (SIS2) is thought to measure inhibition due to the threat of consequences of sexual performance [4]. In general, it does indeed seem to be the case that the dual control model is basically valid: several studies have found evidence for an association between sexual dysfunctions and either high sexual inhibition or low sexual excitation [7,8]. However, in the case of PE, the most reasonable hypothesis would perhaps be that its symptoms should be associated with high rather than low sexual excitation [3]. ...
Article
Full-text available
Premature ejaculation (PE) is a common sexual complaint among men, but its etiology is poorly understood. Previous studies on the dual control model of sexuality has revealed that propensities for sexual excitation and inhibition can contribute to sexual dysfunctions, but few studies have included a measure of premature ejaculation. We sought to explore whether PE is associated with sexual excitation or inhibition. We applied structural equation models to data from a large population-based sample of Finnish adult men. The analyses supported a four-factor solution for the sexual inhibition/sexual excitation short-form scale. The clearest result was that increased symptoms of PE were associated with a greater propensity for sexual excitation (β = 151, p < 001, n = 2953). Importantly, this excitation was intrapersonal, as opposed to stemming from social activities. The results imply that men with PE may have stronger and more rapid reactions to sexual stimuli, which in turn may lead to ejaculating earlier than desired.
... For most individuals, sexual inhibition is adaptive, allowing sexual activities that pose health risks to be avoided. However, if the propensity for sexual inhibition is unduly high, it can impair sexual function 32 -particularly, when sexual excitation levels are low. Conversely, when sexual inhibition is low, and sexual excitation is high, the tendency to report engaging in unsafe sexual behaviors, such as casual and/or unprotected sex, 33,34 is elevated, thereby increasing the risk of disease transmission, pregnancy, and non-volitional sex. ...
Article
Background: A younger age at sexual intercourse has frequently been linked to adverse sexual health outcomes. Yet, little is known about its associations with healthy sexual function, and less still about the timing of pre-coital sexual debuts and adult sexual health. Aim: We examined associations between an earlier sexual debut and subsequent sexual health, using broad operationalizations of each that capture pre-coital experiences and positive outcomes. Connections to sexual health risk and healthy sexual function were assessed through the lens of the dual-control model of sexual response. Methods: Data on age at first sexual intercourse, first sexual contact, first sexual stimulation, and first orgasm, as well as sexual health risk and healthy sexual function were gathered from 3,139 adults. Outcomes: Adverse sexual events (reproductive illness, infection, or injury affecting sexual activity; pregnancy termination and/or loss; non-volitional sex) and current sexual difficulties (Female [FSFI] and/or Male Sexual Function Index [MSFI] scores; Sexual Excitation and/or Sexual Inhibition Inventory for Women and Men [SESII-W/M] scores). Results: When defined narrowly as first sexual intercourse, earlier sexual debut was associated with adverse sexual events, including non-volitional sex, pregnancy termination and/or loss, and reproductive illness, infection, or injury affecting sexual activity. However, it was also related to healthier sexual function, including less pain during vaginal penetration, better orgasmic functioning, and lower sexual inhibition. When sexual debut was broadened to include pre-coital experiences, earlier sexual contact, like earlier sexual intercourse, was associated with non-volitional sex. However, earlier sexual stimulation and orgasm were unrelated to adverse outcomes. Rather, these related to fewer sexual desire difficulties, and greater sexual excitation. Exploratory mediation analyses revealed later sexual intercourse and orgasm were connected to sexual difficulties through higher sexual inhibition and lower sexual excitation, respectively. Clinical implications: When sexual functioning is impaired, delay of both coital and noncoital debuts may warrant assessment, and sexual excitation and inhibition may be targets for intervention. To facilitate healthy sexual development of young people, non-coital debuts with and without a partner may warrant inclusion in risk management and health promotion strategies, respectively. Strengths & limitations: Although this research operationalized sexual debut and sexual health broadly, and examined associations between them, it is limited by its cross-sectional retrospective design and non-clinical convenience sample. Conclusion: From a risk-based perspective, earlier sexual intercourse is adversely related to sexual health. Yet, it is also associated with healthy sexual function. Indeed, earlier sexual initiation may confer more benefits than risks when sexual debuts beyond intercourse are considered. Peragine DE, Skorska MN, Maxwell JA, et al. The Risks and Benefits of Being "Early to Bed": Toward a Broader Understanding of Age at Sexual Debut and Sexual Health in Adulthood. J Sex Med 2022;XX:XXX-XXX.
... Quinta Gomes et al. 12 found positive associations between the SES and sexual arousal, sexual desire, lubrication, and orgasmic function, thus giving weight to the idea that the SIS/SES might not properly capture the full range of inhibiting cues in women. 8 Yet, studies using the SISII-W or the SISII-W/M support the relevance of the DCM in understanding women's sexual response and function, with Sexual Excitability (SE, equivalent to SES) being a positive predictor and Sexual Inhibition (SI, equivalent to SIS1) a negative one (see 14 for a complete review). ...
... In 170 women from the general population, a lack of erotic thoughts during sex, as well as disengagement thoughts (e.g., I am not getting aroused), and sexual passivitysubsumed as cognitive distractionwere strongly associated with orgasmic problems (Cuntim & Nobre, 2011;. A facet of sexual inhibition (i.e., the tendency to prevent sexual arousal in situations where it might be disadvantageous to pursue sexual behavior; Bancroft, Graham, Janssen, & Sanders, 2009;Bancroft & Janssen, 2000) that describes increased distractibility during sex was associated with lower genital sexual arousal (Velten, Scholten, Graham, Adolph, & Margraf, 2016) as well as a greater risk for developing sexual problems (Bloemendaal & Laan, 2015;Velten, 2017;Velten, Scholten, Graham, & Margraf, 2017). Research about sexual mindfulness (i.e., the ability to bring one's attention to experiences in the present moment in a nonjudgmental way during sexual activity; Adam, Heeren, Day, & de Sutter, 2015;Kabat--Zinn & Hanh, 2009) suggests that women who are able to attend to internal (e.g., emotions, cognitions) and external stimuli (e.g., sights, sounds) during sex have higher sexual satisfaction (Leavitt, Lefkowitz, & Waterman, 2019). ...
Article
Attention to sexual stimuli is a prerequisite to process such stimuli as sexually-meaningful and is an important means to facilitate sexual arousal. Attending to sexual cues is crucial for healthy sexual functioning. Studies suggest that sexual dysfunction is associated with less attention towards sexual stimuli. The goal of this study was to use an eye-tracking-based free-viewing paradigm to investigate whether women with sexual dysfunction visually attend to the genital area in dynamic sexual stimuli (i.e., erotic videos) differently than women with subclinical sexual function or those with typical sexual functioning. A total of 69 women (Mage = 27.77, SD = 8.00) with clinical (n = 30), subclinical (n = 23), and typical (n = 16) levels of sexual functioning watched four 1-min video clips depicting heterosexual couples engaging in vaginal intercourse or cunnilingus while the total fixation duration on the genital area as well as their subjective and genital sexual arousal were recorded. As hypothesized, the clinical group fixated on the genital area less than women with typical sexual functioning. A longer total fixation duration on the genital area was followed by increases in subjective arousal and genital arousal. The relationship between attention and arousal was not moderated by sexual functioning group. This study provides first evidence of the role of sustained visual attention for facilitating sexual arousal in women with and without sexual dysfunction.
... Quinta Gomes et al. 12 found positive associations between the SES and sexual arousal, sexual desire, lubrication, and orgasmic function, thus giving weight to the idea that the SIS/SES might not properly capture the full range of inhibiting cues in women. 8 Yet, studies using the SISII-W or the SISII-W/M support the relevance of the DCM in understanding women's sexual response and function, with Sexual Excitability (SE, equivalent to SES) being a positive predictor and Sexual Inhibition (SI, equivalent to SIS1) a negative one (see 14 for a complete review). ...
Article
Full-text available
Introduction The Dual control model proposes that both excitatory and inhibitory processes are responsible for the human sexual response. Aim To validate the French-Canadian translation of the Sexual Inhibition and Excitation Scales-Short Form (SIS/SES-SF) by exploring its factor structure and by investigating its capacity to retrospectively predict sexual functioning and behaviors, namely, sociosexual orientation and sexual compulsivity. Methods A French-Canadian translation of the SIS/SES-SF was created using forward-backward translation. A community sample of 362 men and 420 women completed an online survey. The factor structure and the measurement invariance between men and women was explored using Exploratory Structural Equation Modeling. Predictive power of the scales was tested using Multiple Linear Regression models using a corrected threshold (P< .008). Main outcome measures Sexual functioning was assessed using the International Index of Erectile Function and the Female Sexual Function Index while sexual compulsion and sociosexual orientation were measured using the Sexual Compulsion Scale and the Revised Sociosexual Orientation Inventory, respectively. Results The original three-factor solution of the SIS/SES-SF was replicated. All three scales showed acceptable internal consistency and good temporal stability. Yet, results only supported configural measurement invariance between men and women, suggesting that their scores cannot be directly compared. Overall, for both men and women, higher sexual excitation (SES) was significantly predictive of better sexual functioning, while higher sexual inhibition due to threat of performance failure (SIS1) was a significant predictor of lower sexual functioning. Both sexual compulsivity and sociosexual orientation were significantly predicted by higher SES and lower sexual inhibition due to threat of performance consequences (SIS2). Conclusion These results support the cross-cultural transferability of the SIS/SIS-SF and the Dual control model to French-Canadian men and women, higlighting the utility for clinicians to evaluate both excitatory and inhibitory factors associated with sexual dysfunction and sexual behaviors. Nolet K, Guay JP, Bergeron S. Validation of the French-Canadian Version of the Sexual Inhibition and Sexual Excitation Scales-Short Form (SIS/SES-SF): Associations With Sexual Functioning, Sociosexual Orientation, and Sexual Compulsivity. Sex Med 2021;9:100374.
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Introduction Hypoactive Sexual Desire Disorder (HSDD) / Female Sexual Interest/Arousal Disorder (FSIAD) impacts health-related quality of life (HRQoL) of women and their partners, yet existing measures fail to adequately capture relevant concepts (ie, what is essential to measure including symptoms/impacts) important to women with HSDD/FSIAD. Objectives To identify HRQoL tools used to assess women with HSDD/FSIAD, and to evaluate their psychometric properties (ie, reliability, validity, and responsiveness). Methods We conducted searches in PubMed, Embase and PsychINFO from June 5, 1989 to September 30, 2020 for studies in women with HSDD/FSIAD and psychometric analyses (English only). Principles of the Preferred Reporting Items for Systematic reviews and Meta-Analyses, the COnsensus-based Standards for the selection of health Measurement INstruments Risk of Bias Checklist and other psychometric criteria were applied. Based on this search, 56 papers were evaluated including 15 randomized-controlled trials, 11 observational/single arm/open label studies, and 30 psychometric studies. Results Of the 18 measures identified, the Female Sexual Function Index (FSFI) and Female Sexual Distress Scale-Revised (FSDS-R) were included in most studies (> 50%). General HRQoL instruments were not used in any of the clinical trials; the SF-12, SF-36 and EQ-5D-5L were reported in two observational studies. No instruments achieved positive quality ratings across all psychometric criteria. The FSFI, FSDS-R, Sexual Event Diary (SED) and the Sexual Desire Relationship Distress Scale (SDRDS), were the only measures to receive a positive rating for content validity. Conclusion Reliable and valid HRQoL measures that include sexual desire and distress are needed to provide a more systematic and comprehensive assessment of HRQoL and treatment benefits in women with HSDD/FSIAD. While inferences about HRQoL are limited due to the lack of uniformity in concepts assessed and limited psychometric evaluation of these measures in women with HSDD/FSIAD, opportunities exist for the development of reliable and validated tools that comprehensively measure the most relevant and important concepts in women with HSDD/FSIAD. Lim-Watson MZ, Hays RD, Kingsberg S, et al. A systematic literature review of health-related quality of life measures for women with Hypoactive Sexual Desire Disorder and Female Sexual Interest/Arousal Disorder. Sex Med Rev 2021;XX:XXX–XXX.
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Background: Bisexual and mostly heterosexual women report higher substance use than exclusively heterosexual or lesbian women. In sexual minority men, sex-linked substance use (SLSU) can increase risk for substance use problems; equivalent research in women is lacking. Objectives: To test if sexual excitation and inhibition mediate the association between sexual minority status and women’s SLSU. Methods: We surveyed a convenience sample of 595 undergraduate women who identified as exclusively heterosexual (n = 499), mostly heterosexual (n = 59), or bisexual (n = 37). Participants reported on their last month use of alcohol, cannabis, and other drugs (e.g., cocaine) in sexual and non-sexual contexts, and symptoms of alcohol and non-alcohol drug use disorders (e.g., withdrawal symptoms). Drug use symptoms were collapsed across non-alcohol substances. We used structural equation modeling to test serial mediations of women’s SLSU and overall drug and alcohol use. Results: Bisexual and mostly heterosexual women reported higher cannabis use (η² = 0.030) and drug use disorder symptoms (η² = 0.050) than heterosexual women. Mostly heterosexual women’s SLSU was a stronger predictor of alcohol use (η² = 0.019) and binge drinking frequency (η² = 0.015) than for other orientation groups. Bisexual and mostly heterosexual women’s higher sexual excitation predicted their higher SLSU, which in turn predicted higher cannabis use frequency and drug use disorder symptoms. However, sexual inhibition failed to mediate either SLSU or overall substance use. Conclusion: These findings point to SLSU as a mechanism by which sexual minority women may experience disparities in substance use related harms.
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Background/Objective: The Dual Control Model suggests that sexual excitation and associated behaviors are the result of the balance between relatively independent excitatory and inhibitory mechanisms. Based on this theoretical model, the Sexual Excitation/Sexual Inhibition Inventory for Women (SESII-W) was developed to evaluate excitation and inhibition dimensions in women. The aim was to adapt and validate the SESII-W in the Spanish population. Method: A sample of 1,380 heterosexual women (aged 18 to 52) completed the Spanish SESII-W, together with other related instruments. After the translation and adaptation of the SESII-W, a Confirmatory Factor Analysis (CFA) was performed. Results: CFA resulted in a version consisting of 33 items divided into eight sub-factors, which were grouped into two higher-order factors (Sexual Excitation and Sexual Inhibition). The sub-factors demonstrated adequate internal consistency values except for Sexual Power Dynamics and Concerns about Sexual Function. Test-retest reliabilities were good. Their scores correlated with erotophilia, sexual sensation seeking, age at first intercourse, and number of sexual partners in the expected direction. Conclusions: The Spanish version of SESII-W has adequate psychometric guarantees for use in clinical practice and research, although it would be necessary to further revise factors that showed a lower level of reliability.
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The present paper gives an overview of the methodology and results of the first decade of research into Internet-based interventions for women’s sexual dysfunction. The interventions, retrieved in a literature search, were mostly well grounded on common theoretical models of sexual dysfunction and psychological disorders, and most ingredients of the interventions were theory-informed. Most interventions offered Web-based therapeutic content within a more or less preprogrammed structure. Most of these also offered prescheduled and/or participant-initiated contact with a sexual health care professional. Comparative effect studies showed improvements in sexual functioning as well as relational functioning at the point of termination of the intervention period. Improvements at posttreatment were generally maintained for several months after termination of the active intervention period. The results of this review seem to warrant further development of Internet-based interventions for women’s sexual dysfunctions.
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The agreement of subjective and genital sexual response, also referred to as sexual concordance, shows substantial variability between women. Identifying predictors of sexual arousal and sexual concordance is important to improve our understanding of female sexual response and its relationship to sexual function or dysfunction. The aim of this study was to assess the relevance of sexual excitation and sexual inhibition as predictors of subjective sexual arousal, genital arousal, and sexual concordance. In a laboratory setting, sexual arousal was induced by erotic video stimuli. Subjective sexual arousal was assessed continuously during stimulus presentation and genital arousal was measured with vaginal photoplethysmography. Data of 58 women (M age = 24.95, SD = 4.65) were analyzed using multilevel analyses (HLM). This data analytic technique estimates the within-subject associations of subjective and genital arousal, by controlling for between-subject differences. An interaction term of sexual excitation and sexual inhibition significantly predicted genital sexual arousal. In exploratory analyses, two lower order factors of sexual inhibition (Concerns about Sexual Function and Arousal Contingency) were predictive of sexual concordance. Further examination of these associations might increase our knowledge of female sexual function and deepen our understanding of how sexual excitation and sexual inhibition affect sexual arousal and consequently, impact sexual behaviors, in women.
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To date no longitudinal studies have evaluated the predictive value of the two factors of the Dual Control Model—sexual excitation (SE) and sexual inhibition (SI)—for future sexual function. The aims of the present study were to investigate the associations between SE/SI and sexual function and estimate their predictive value for future sexual function in a sample of women. Overall, 2,214 women participated in a web-based survey that assessed SE, SI, and sexual function as well as symptoms of depression. The one and two-year follow-up surveys included 396 and 380 participants, respectively. Correlational analyses and hierarchical regression analyses were conducted to analyze the relationships between predictor and outcome variables. Four factors of SE (Arousability, Partner Characteristics, Sexual Power Dynamics, and Setting) and two factors of SI (Concerns about Sexual Function and Arousal Contingency), as well as symptoms of depression and partnership status were significant predictors of concurrent and future sexual function. Several subscales of SE and SI contributed to the prediction of future sexual function above and beyond prior sexual function levels. Our study provides the first supportive evidence for the assumptions of the Dual Control Model that propensities for low SE and high SI influence future sexual function.
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Establishing the clinical significance of symptoms of sexual dysfunction is challenging. To address this, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) introduced two new morbidity criteria (duration and symptom severity) to the existing criteria of distress. This study sought to establish the impact of these three criteria on the population prevalence of sexual function problems. The data come from a national probability survey (Natsal-3) and are based on 11,509 male and female participants aged 16-74, reporting at least one sexual partner in the past year. The key outcomes were: proportion of individuals reporting proxy measures of DSM-5 problems, and the proportion of those meeting morbidity criteria. We found that among sexually active men, the prevalence of reporting one or more of four specific sexual problems was 38.2%, but 4.2% after applying the three morbidity criteria; corresponding figures for women reporting one or more of three specific sexual problems, were 22.8% and 3.6%. Just over a third of men and women reporting a problem meeting all three morbidity criteria had sought help in the last year. We conclude that the DSM-5 morbidity criteria impose a focus on clinically significant symptoms.
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The aim of this study was to use the dual control model of sexual response (DCM) to investigate variation in sexual well-being among women 50 years of age and older. Data from 185 women 50 years of age and older (M = 59.46, SD = 6.96) were used to examine the relationships between sexual excitation (SE) and sexual inhibition (SI) and their lower-order factors to indicators of sexual well-being (i.e., sexual functioning, satisfaction, distress, frequency of sexual activity, and breadth of sexual behavior). Possible moderating factors were also explored. Independently, SE and SI were associated with the majority of the indicators of sexual well-being, and the directions of associations were consistent with the tenets of the DCM. SE and SI lower-order factors were significant predictors of sexual function, satisfaction, and frequency of sexual activity. Sexual distress was predicted more strongly by SI factors and breadth of sexual behavior by one SE lower-order factor (arousability). Partner physical and mental health and participant’s own mental health were identified as moderating variables of these associations. Findings of this study are discussed considering the contribution of the DCM to understanding the role of diversity in older women’s sexual well-being.
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Introduction: Women's sexuality is influenced by their perceptions of their bodies. Negative body appraisals have been implicated in the development and maintenance of sexual concerns in women with a history of childhood sexual abuse (CSA). The sexuality of these women is often expressed in extremes of approach and avoidant sexual tendencies, which have been related to the sexual inhibition and sexual excitation pathways of the dual control model. Aim: To test the influence of body esteem on the sexual excitation and inhibition responses of women with and without a history of CSA. Methods: One hundred thirty-nine women with CSA and 83 non-abused women reported on their abuse history, depressive symptomology, sexual response, and affective appraisals of their body. Main Outcome Measures: Validated self-report measurements of sexual excitation and inhibition responses (Sexual Excitation/Sexual Inhibition Inventory for Women) and body esteem (Body Esteem Scale) were administered. Results: Body esteem was significantly associated with sexual inhibition responses of women regardless of CSA history status but was significantly related only to the sexual excitation responses of women with a CSA history. Perceived sexual attractiveness was a unique predictor of sexual excitation in women with a history of CSA. Conclusion: Women with a history of CSA have lower body esteem than non-abused women, particularly in self-perceived sexual attractiveness, and these perceptions appear to influence their sexual responses by acting on the sexual excitation and inhibition response pathways.
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Aim: The SESII-W/M is a self-report measure assessing factors that inhibit and enhance sexual arousal in men and women. The goal of this study was to adapt and validate it in a sample of Portuguese men and women. Method: A total of 1,723 heterosexual men and women participated through a web survey, ages ranging from 18 to 72 years old (M = 36.05, SD = 11.93). Results: The levels of internal consistency were considered satisfactory in the first four factors, but not in Setting and Dyadic Elements of the Sexual Interaction. Confirmatory factor analysis partially supported the six-factor, 30-item model, as factor loadings and squared multiple correlations pointed to problems with items mainly loading on those two factors. General fit indices were lower than the ones estimated by Milhausen et al. ( 2010 ). Psychometric sensitivity and construct validity were adequate and gender differences were consistent with the original study. Conclusions: The 6 factor, 30-item model, was retained but changes to the factors Setting and Dyadic Elements of the Sexual Interaction, and their corresponding items, were recommended in order to strengthen the measure.
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The Sexual Excitation/Sexual Inhibition Inventory for Women (SESII-W) assesses propensities for sexual excitation (SE) and inhibition (SI). Previous research utilizing the SESII-W included samples comprised exclusively or almost entirely of heterosexual women. The purpose of this study was to examine the psychometric properties of the SESII-W and assess its relation to aspects of sexual function within a sample of lesbian and bisexual women. The sample included 974 self-identified bisexual (n = 733) or lesbian/homosexual (n = 241) women who completed an online survey including items assessing women's sexual behaviors, feelings, and functioning, sociodemographics, and the SESII-W. The sample was split; exploratory factor analyses were conducted on the first half, yielding eight lower-order factors with two higher-order factors. Confirmatory factor analysis was conducted on the second half and suggested reasonable model fit. SI was positively correlated with sexual problems and negatively correlated with sexual pleasure; the correlations were significant but small. Hierarchical regression analyses were conducted to examine the relationships between SESII-W scores and sexual problems/sexual pleasure, controlling for age, relationship duration, and relationship status. Four lower-order factors predicted reports of sexual problems. Findings indicated the SESII-W has similar psychometric properties among sexual minority women as it does among heterosexual women.